Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,169.26

Service Code	MSDRG 750
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,169.26
Rate for Payer: Aetna of CA HMO/PPO	$39,092.48
Rate for Payer: EPIC Health Plan Commercial	$43,169.26
Rate for Payer: EPIC Health Plan Senior	$31,977.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,977.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,977.23
Rate for Payer: Molina Healthcare of CA Medicare	$42,849.49
Rate for Payer: Multiplan WC	$24,089.73
Rate for Payer: Prime Health Services WC	$23,843.92
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$321,191.96

Service Code	MSDRG 215
Min. Negotiated Rate	$129,853.26
Max. Negotiated Rate	$321,191.96
Rate for Payer: Aetna of CA HMO/PPO	$321,191.96
Rate for Payer: EPIC Health Plan Commercial	$175,301.90
Rate for Payer: EPIC Health Plan Senior	$129,853.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$129,853.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$129,853.26
Rate for Payer: Molina Healthcare of CA Medicare	$174,003.37
Rate for Payer: Multiplan WC	$197,926.27
Rate for Payer: Prime Health Services WC	$195,906.61
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$207,861.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$69,220.52

Service Code	MSDRG 424
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$69,220.52
Rate for Payer: Aetna of CA HMO/PPO	$69,220.52
Rate for Payer: EPIC Health Plan Commercial	$57,280.92
Rate for Payer: EPIC Health Plan Senior	$42,430.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,430.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,430.31
Rate for Payer: Molina Healthcare of CA Medicare	$56,856.62
Rate for Payer: Multiplan WC	$42,655.36
Rate for Payer: Prime Health Services WC	$42,220.10
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$123,307.30

Service Code	MSDRG 423
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$123,307.30
Rate for Payer: Aetna of CA HMO/PPO	$123,307.30
Rate for Payer: EPIC Health Plan Commercial	$82,614.64
Rate for Payer: EPIC Health Plan Senior	$61,196.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,196.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,196.03
Rate for Payer: Molina Healthcare of CA Medicare	$82,002.68
Rate for Payer: Multiplan WC	$75,984.95
Rate for Payer: Prime Health Services WC	$75,209.59
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$46,862.47

Service Code	MSDRG 425
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,862.47
Rate for Payer: Aetna of CA HMO/PPO	$46,862.47
Rate for Payer: EPIC Health Plan Commercial	$46,808.64
Rate for Payer: EPIC Health Plan Senior	$34,673.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,673.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,673.07
Rate for Payer: Molina Healthcare of CA Medicare	$46,461.91
Rate for Payer: Multiplan WC	$28,877.79
Rate for Payer: Prime Health Services WC	$28,583.12
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$39,769.84

Service Code	MSDRG 868
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,769.84
Rate for Payer: Aetna of CA HMO/PPO	$31,834.83
Rate for Payer: EPIC Health Plan Commercial	$39,769.84
Rate for Payer: EPIC Health Plan Senior	$29,459.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,459.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,459.14
Rate for Payer: Molina Healthcare of CA Medicare	$39,475.25
Rate for Payer: Multiplan WC	$19,617.40
Rate for Payer: Prime Health Services WC	$19,417.22
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$65,006.60

Service Code	MSDRG 867
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$65,006.60
Rate for Payer: Aetna of CA HMO/PPO	$65,006.60
Rate for Payer: EPIC Health Plan Commercial	$55,307.16
Rate for Payer: EPIC Health Plan Senior	$40,968.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,968.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,968.27
Rate for Payer: Molina Healthcare of CA Medicare	$54,897.48
Rate for Payer: Multiplan WC	$40,058.64
Rate for Payer: Prime Health Services WC	$39,649.88
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$35,076.82

Service Code	MSDRG 869
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,076.82
Rate for Payer: Aetna of CA HMO/PPO	$21,815.39
Rate for Payer: EPIC Health Plan Commercial	$35,076.82
Rate for Payer: EPIC Health Plan Senior	$25,982.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,982.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,982.83
Rate for Payer: Molina Healthcare of CA Medicare	$34,816.99
Rate for Payer: Multiplan WC	$13,443.17
Rate for Payer: Prime Health Services WC	$13,305.99
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$51,215.85

Service Code	MSDRG 922
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$51,215.85
Rate for Payer: Aetna of CA HMO/PPO	$51,215.85
Rate for Payer: EPIC Health Plan Commercial	$48,847.74
Rate for Payer: EPIC Health Plan Senior	$36,183.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,183.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,183.51
Rate for Payer: Molina Healthcare of CA Medicare	$48,485.90
Rate for Payer: Multiplan WC	$31,560.45
Rate for Payer: Prime Health Services WC	$31,238.40
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$39,341.00

Service Code	MSDRG 923
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,341.00
Rate for Payer: Aetna of CA HMO/PPO	$30,919.29
Rate for Payer: EPIC Health Plan Commercial	$39,341.00
Rate for Payer: EPIC Health Plan Senior	$29,141.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,141.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,141.48
Rate for Payer: Molina Healthcare of CA Medicare	$39,049.58
Rate for Payer: Multiplan WC	$19,053.22
Rate for Payer: Prime Health Services WC	$18,858.80
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$39,341.00

Service Code	MSDRG 699
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,341.00
Rate for Payer: Aetna of CA HMO/PPO	$30,919.29
Rate for Payer: EPIC Health Plan Commercial	$39,341.00
Rate for Payer: EPIC Health Plan Senior	$29,141.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,141.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,141.48
Rate for Payer: Molina Healthcare of CA Medicare	$39,049.58
Rate for Payer: Multiplan WC	$19,053.22
Rate for Payer: Prime Health Services WC	$18,858.80
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$50,958.16

Service Code	MSDRG 698
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$50,958.16
Rate for Payer: Aetna of CA HMO/PPO	$50,958.16
Rate for Payer: EPIC Health Plan Commercial	$48,727.02
Rate for Payer: EPIC Health Plan Senior	$36,094.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,094.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,094.09
Rate for Payer: Molina Healthcare of CA Medicare	$48,366.08
Rate for Payer: Multiplan WC	$31,401.66
Rate for Payer: Prime Health Services WC	$31,081.23
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$34,716.18

Service Code	MSDRG 700
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,716.18
Rate for Payer: Aetna of CA HMO/PPO	$21,045.37
Rate for Payer: EPIC Health Plan Commercial	$34,716.18
Rate for Payer: EPIC Health Plan Senior	$25,715.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,715.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,715.69
Rate for Payer: Molina Healthcare of CA Medicare	$34,459.02
Rate for Payer: Multiplan WC	$12,968.66
Rate for Payer: Prime Health Services WC	$12,836.33
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$69,981.45

Service Code	MSDRG 674
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$69,981.45
Rate for Payer: Aetna of CA HMO/PPO	$69,981.45
Rate for Payer: EPIC Health Plan Commercial	$57,637.35
Rate for Payer: EPIC Health Plan Senior	$42,694.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,694.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,694.33
Rate for Payer: Molina Healthcare of CA Medicare	$57,210.40
Rate for Payer: Multiplan WC	$43,124.27
Rate for Payer: Prime Health Services WC	$42,684.23
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$127,011.91

Service Code	MSDRG 673
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$127,011.91
Rate for Payer: Aetna of CA HMO/PPO	$127,011.91
Rate for Payer: EPIC Health Plan Commercial	$84,349.85
Rate for Payer: EPIC Health Plan Senior	$62,481.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,481.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,481.37
Rate for Payer: Molina Healthcare of CA Medicare	$83,725.04
Rate for Payer: Multiplan WC	$78,267.82
Rate for Payer: Prime Health Services WC	$77,469.17
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$47,453.63

Service Code	MSDRG 675
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$47,453.63
Rate for Payer: Aetna of CA HMO/PPO	$47,453.63
Rate for Payer: EPIC Health Plan Commercial	$47,085.56
Rate for Payer: EPIC Health Plan Senior	$34,878.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,878.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,878.19
Rate for Payer: Molina Healthcare of CA Medicare	$46,736.77
Rate for Payer: Multiplan WC	$29,242.08
Rate for Payer: Prime Health Services WC	$28,943.69
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$104,420.43

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$104,420.43
Rate for Payer: Aetna of CA HMO/PPO	$104,420.43
Rate for Payer: EPIC Health Plan Commercial	$73,768.24
Rate for Payer: EPIC Health Plan Senior	$54,643.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,643.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,643.14
Rate for Payer: Molina Healthcare of CA Medicare	$73,221.81
Rate for Payer: Multiplan WC	$64,346.40
Rate for Payer: Prime Health Services WC	$63,689.80
Rate for Payer: United Healthcare All Other Commercial	$63,629.00
Rate for Payer: United Healthcare All Other HMO	$55,944.00
Rate for Payer: United Healthcare HMO Rider	$42,494.00
Rate for Payer: United Healthcare Select/Navigate/Core	$38,930.00

MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$155,612.03

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$155,612.03
Rate for Payer: Aetna of CA HMO/PPO	$155,612.03
Rate for Payer: EPIC Health Plan Commercial	$97,745.87
Rate for Payer: EPIC Health Plan Senior	$72,404.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,404.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$72,404.35
Rate for Payer: Molina Healthcare of CA Medicare	$97,021.83
Rate for Payer: Multiplan WC	$95,891.90
Rate for Payer: Prime Health Services WC	$94,913.41
Rate for Payer: United Healthcare All Other Commercial	$95,869.00
Rate for Payer: United Healthcare All Other HMO	$84,289.00
Rate for Payer: United Healthcare HMO Rider	$64,025.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,657.00

MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$75,856.70

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$75,856.70
Rate for Payer: Aetna of CA HMO/PPO	$75,856.70
Rate for Payer: EPIC Health Plan Commercial	$60,389.27
Rate for Payer: EPIC Health Plan Senior	$44,732.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,732.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,732.79
Rate for Payer: Molina Healthcare of CA Medicare	$59,941.94
Rate for Payer: Multiplan WC	$46,744.74
Rate for Payer: Prime Health Services WC	$46,267.75
Rate for Payer: United Healthcare All Other Commercial	$45,573.00
Rate for Payer: United Healthcare All Other HMO	$40,069.00
Rate for Payer: United Healthcare HMO Rider	$30,435.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,883.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$40,491.20

Service Code	MSDRG 729
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,491.20
Rate for Payer: Aetna of CA HMO/PPO	$33,374.88
Rate for Payer: EPIC Health Plan Commercial	$40,491.20
Rate for Payer: EPIC Health Plan Senior	$29,993.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,993.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,993.48
Rate for Payer: Molina Healthcare of CA Medicare	$40,191.26
Rate for Payer: Multiplan WC	$20,566.42
Rate for Payer: Prime Health Services WC	$20,356.56
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$33,476.53

Service Code	MSDRG 730
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,476.53
Rate for Payer: Aetna of CA HMO/PPO	$18,398.78
Rate for Payer: EPIC Health Plan Commercial	$33,476.53
Rate for Payer: EPIC Health Plan Senior	$24,797.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,797.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,797.43
Rate for Payer: Molina Healthcare of CA Medicare	$33,228.56
Rate for Payer: Multiplan WC	$11,337.78
Rate for Payer: Prime Health Services WC	$11,222.09
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$56,251.34

Service Code	MSDRG 717
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$56,251.34
Rate for Payer: Aetna of CA HMO/PPO	$56,251.34
Rate for Payer: EPIC Health Plan Commercial	$51,206.31
Rate for Payer: EPIC Health Plan Senior	$37,930.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,930.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,930.60
Rate for Payer: Molina Healthcare of CA Medicare	$50,827.00
Rate for Payer: Multiplan WC	$34,663.43
Rate for Payer: Prime Health Services WC	$34,309.72
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$42,351.36

Service Code	MSDRG 718
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$42,351.36
Rate for Payer: Aetna of CA HMO/PPO	$37,346.28
Rate for Payer: EPIC Health Plan Commercial	$42,351.36
Rate for Payer: EPIC Health Plan Senior	$31,371.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,371.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,371.38
Rate for Payer: Molina Healthcare of CA Medicare	$42,037.65
Rate for Payer: Multiplan WC	$23,013.68
Rate for Payer: Prime Health Services WC	$22,778.85
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$68,462.62

Service Code	MSDRG 715
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,462.62
Rate for Payer: Aetna of CA HMO/PPO	$68,462.62
Rate for Payer: EPIC Health Plan Commercial	$56,925.94
Rate for Payer: EPIC Health Plan Senior	$42,167.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,167.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,167.36
Rate for Payer: Molina Healthcare of CA Medicare	$56,504.26
Rate for Payer: Multiplan WC	$42,188.32
Rate for Payer: Prime Health Services WC	$41,757.83
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$45,012.39

Service Code	MSDRG 716
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,012.39
Rate for Payer: Aetna of CA HMO/PPO	$43,027.50
Rate for Payer: EPIC Health Plan Commercial	$45,012.39
Rate for Payer: EPIC Health Plan Senior	$33,342.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,342.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,342.51
Rate for Payer: Molina Healthcare of CA Medicare	$44,678.96
Rate for Payer: Multiplan WC	$26,514.59
Rate for Payer: Prime Health Services WC	$26,244.03
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

Know your out-of-pocket cost for care.

All Charges